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Senate Republican leaders return to Washington this week with just enough time to pass reconciliation and get home to see 4th of July fireworks. But Congress and the administration also have to deal with the fallout from the bombing of Iran. There is certainly a lot going on in DC! So, let’s get into it – welcome to the Week Ahead!
The Administration
The Centers for Medicare and Medicaid Services (CMS) has kicked off its own fireworks show by finalizing the 2025 Marketplace Integrity and Affordability Final Rule. The final rule largely retains the provisions of the proposed rule released in March, including shortening of the Affordable Care Act (ACA) open enrollment period and prohibiting ACA coverage for Deferred Action for Childhood Arrivals (DACA) recipients.
However, the rule also finalizes other parts of the proposal on a temporary basis, including several provisions strengthening income eligibility requirements. Why would CMS do that?
According to reports, by sunsetting some of the rule’s provisions, Congress could get “budget credit” if these provisions are included in the final reconciliation bill being debated in Congress. The Congressional Budget Office (CBO) previously estimated that many of these same provisions in the House-passed version of the reconciliation bill would save $101 billion over ten years.
The Senate draft did not include these provisions, but having an extra >$100 billion of “walking around money” could be very useful to Republican leaders either to reduce the overall cost of the bill or mitigate the need for savings from other controversial provisions like Medicaid provider taxes or state directed payments.
We expect CMS to finalize several other final rules over the next month, including rules setting Medicare payment rates for the coming year. These rules will set the stage for how Medicare reimburses different providers and services.
The Senate
Senate Republicans are feeling the heat, and it’s not just because of the temperature. Ever since the Senate Finance Committee released its reconciliation text on June 16, several Republican Senators have raised concerns about those provisions. For example, there are concerns about proposed reductions in the use of provider taxes to 3.5% by 2031 for Medicaid expansion states, as well as an annual 10% reduction in state directed payments until they match Medicare rates. This group includes Sens. Josh Hawley (R-MO), Jim Justice (R-WV), Lisa Murkowski (R-AK), and Susan Collins (R-ME). When you add in Senators such as Sens. Ron Johnson (R-WI) and Rand Paul (R-KY), who have raised concerns about the bill’s impact on the deficit, you are up to six Senators with major concerns over the current draft. Remember, Republicans can only afford three no votes and still pass the reconciliation bill. That’s certainly enough to make Senate Republican leadership sweat.
That said, conversations are continuing to address these Medicaid concerns. For example, Sen. Hawley has been pitching a return to the House-passed moratorium on new provider taxes and changes to state directed payments with additional guarantees that existing rates would be grandfathered in. Additionally, there have been discussions about creating a fund to help rural hospitals survive any changes to provider taxes or state directed payments. Something will need to be done to ensure the bill doesn’t burn up on the Senate floor.
In non-reconciliation news, the Senate Committee on Health, Education, Labor, and Pensions (HELP) is scheduled to consider the nomination of Dr. Susan Monarez to be the Director of the Centers for Disease Control and Prevention (CDC) on June 25. Expect this hearing to feature fiery remarks about the removal and replacement of the entire CDC’s Advisory Committee on Immunization Practices (ACIP) by Health and Human Services Sec. Kennedy.
Other Health Care Hearings
- June 25: Senate Aging Committee hearing on sports medicine’s role in older Americans’ health
- June 25: Senate VA Committee hearing on the Veterans Crisis Line
The House
House Speaker Mike Johnson (R-LA) is prepared to cancel the House’s upcoming recess if it means there is a chance that the reconciliation bill could be sent to President Trump’s desk before July 4th. But even with additional time, navigating the various factions within the House GOP caucus will be more difficult than leaving the National Mall after the fireworks end. That’s because, in addition to addressing concerns from members about Medicaid or the deficit, the Speaker also has to find a way to address concerns from House Republicans on the SALT Caucus.
The Senate reconciliation bill’s dropping of the SALT deduction cap from $40,000 to $10,000 is an insult to the SALT Caucus GOP members. Senate Republican leaders say their amount is a placeholder amount for negotiations, but it’s hard to see how that number makes GOP SALT Caucus members excited to come to the table.
Meanwhile, the House Budget Committee will be wading into the debate over Medicaid work requirements at a June 25 hearing. While not specifically mentioning Medicaid in the announcement, we expect Republicans to use the hearing as a platform to argue in support of provisions of the reconciliation bill that implement work requirements for certain individuals enrolled in Medicaid and the Supplemental Nutrition Assistance Program. Expect Democrats to use their time to highlight what they argue will be the detrimental effects of such policies on beneficiaries, although they have yet to name a witness for the hearing.
Other Health Hearings
- June 23: House Appropriations Committee continued markup of FY 26 Ag-FDA bill
- June 24: House Energy and Commerce Health Subcommittee hearing on FY 26 HHS budget
- June 25: House Ways and Means Health Subcommittee hearing on digital health
There You Have It
June 20 marked the Summer Solstice and First Day of Summer for the Northern hemisphere, otherwise known as the longest day of the year. How did you make use of the extra daylight? Let us know. Make it a great week!
Coalition meetings with policymakers are powerful opportunities—but only if they’re well-prepared. A successful meeting requires more than showing up with shared goals; it demands coordination, clarity, and a thoughtful approach to who delivers which message. When each coalition partner knows their role and contributes strategically, the group can present a united, persuasive front that leaves a lasting impression on decision-makers.
Maximizing Policy Meetings Through Strategic Coalition Preparation
Coalition meetings with policymakers are high-stakes opportunities to drive your message forward. When done right, they show unity, strength, and shared purpose. But these meetings don’t just happen—they require thoughtful planning, coordination, and a smart use of resources. Here’s how to make the most of your coalition’s next policy meeting.
Assign Roles and Play to Strengths
Before the meeting, identify which coalition members are best positioned to speak on specific policy points. For example, if one organization has deep expertise in how a policy impacts a particular population, let them lead that part of the conversation. If a coalition partner can bring a constituent voice to the table—someone directly affected by the issue—consider starting the meeting with their story to set a compelling tone. Map out the speaking order, assign key messages to each speaker, and make sure everyone keeps their remarks focused and impactful.
Make the Case for Why You Matter
Every policymaker meeting should begin by establishing credibility. Why should this office pay attention to your group? Use your coalition’s collective reach to your advantage—highlight your members’ expertise, geographic footprint, and community presence. Whether it’s a strong presence in the policymaker’s district or a specialized industry perspective, demonstrate clearly why your coalition’s voice matters.
Leverage Coalition Resources for Greater Impact
One of the greatest benefits of working in a coalition is having access to a range of tools and resources. Tap into these assets to strengthen your message. A policy organization within your coalition might provide compelling data, while a corporate partner might offer powerful visuals or localized insights. Sharing these materials during or after the meeting can reinforce your points and leave a lasting impression.
Use Principals for High-Level Engagement
When engaging at a higher level—such as with senior congressional staff or members themselves—consider bringing in principals from your coalition organizations. Having CEOs, executive directors, or other high-profile leaders speak to shared goals can signal just how serious and unified your coalition is about the issue. Their participation underscores commitment and can help build momentum toward your desired policy outcome.
Keep in Mind
Coalition meetings are most effective when they’re carefully orchestrated. By assigning clear roles, using your members’ unique strengths, and delivering a polished, unified message, you’ll be better positioned to influence policy and build long-term relationships with decision-makers. With the right preparation, your coalition can become a force that policymakers not only hear—but remember.
Chamber Hill Strategies
When it comes to coalition building, Chamber Hill Strategies stands out among lobbying firms in DC. Our comprehensive approach helps clients achieve their advocacy goals. With strong relationships on Capitol Hill and a track record of shaping health policy, we turn complex challenges into real-world wins.
Let our expertise in Washington, DC, guide your efforts towards successful and meaningful stakeholder engagement. Look for our next blog about successfully identifying the right partners.
It’s a high-stakes week in Washington as Senate Republicans work furiously to finalize their budget reconciliation bill and as Republicans’ self-imposed July 4 deadline gets ever closer. Meanwhile, the Trump administration continues to work on drug pricing reform. Let’s get into it. Welcome to the Week Ahead!
The Administration
The Trump administration is looking at advancing its “Most Favored Nation” (MFN) policy as a demonstration through the Center for Medicare and Medicaid Innovation (CMMI). The proposal would tie the price of blockbuster drugs in the U.S. to the lowest prices paid in OECD countries, adjusted for rebates.
The possibility of this new model comes as manufacturers were dealt an ultimatum: cut prices voluntarily by June 12 or face regulatory roulette. The price benchmark? The lowest among countries with a GDP per capita of at least 60% of the U.S.—a move that could shake up the entire pricing deck. Discussions among pharmaceutical executives and administration officials are taking place behind closed doors. However, the policy is still being shuffled, and no one is yet sure who will emerge with the winning hand
But that’s not the only game in town. The Trump administration is also seeking to turn the tables on foreign players who they feel are freeloading off U.S. innovation. Specifically, they’re eyeing trade tools such as those found under Section 301 of the Trade Act of 1974. Additionally, a report is expected soon on an investigation into the effects of pharmaceutical imports on national security (aka a “Section 232 report”). Both of these actions could result in the administration dealing out tariffs or other retaliatory actions against countries with strict price controls.
The Senate
Over in the Senate, the stakes couldn’t be higher as lawmakers head into what’s shaping up to be a critical week for meeting the self-imposed July 4 deadline for passage of a budget reconciliation bill. Senate Finance Committee Chair Mike Crapo (R-ID) is set to present on the committee’s provisions, including the tax and health care provisions, on June 16 at a GOP conference meeting. Meanwhile, the Senate Parliamentarian is playing the role of dealer, making sure every provision of the legislative text comports with the complex Byrd Rule. The July 4th recess is looming over the whole game, and lawmakers are racing the clock to wrap negotiations before the fireworks fly.
One of the biggest issues in the negotiations is over State and Local Income Tax (SALT) deductions. Negotiators are caught between a rock and a hard place: a $30,000 cap can’t clear the House, but a $40,000 cap can’t make it through the Senate. On one side of the table, you have blue state Republicans, like Rep. Mike Lawler (R-NY), threatening to vote no if the Senate does not preserve enough of a deduction. On the other side of the Capitol, Republican Senators, who don’t represent many constituents impacted by high state and local income taxes, but have voiced concerns over the house passed cap. Will the Senate jam the House, or can they come to an agreement during a truncated conference committee process?
For health care, many Republicans like Senators Josh Hawley (R-MO), Susan Collins (R-ME), Lisa Murkowski (R-AK), and Jim Justice (R-WV) are concerned about the Medicaid provisions, such as limits on provider taxes, work requirements, and new copays. On the other side, Sens. Rand Paul (R-KY), Rick Scott (R-FL), and Mike Lee (R-UT) are wanting to up the ante on spending cuts. Senate Republican leadership can’t lose more than three members if they want to pass the bill.
Some Republican members, such as Rep. Young Kim (R-CA), have a stake in both the SALT and Medicaid games. It’s possible that Senate Republican leadership tries to make reductions to SALT easier to swallow by pushing back work requirements or grandfathering existing provider tax rates. However, that will no doubt anger conservatives in both chambers. Balancing both interests has turned this into a real high-wire act, with leadership trying to keep the coalition together without losing key votes. Much like a table full of pros waiting for someone to blink, everyone’s watching for tells, backroom deals, and surprise plays that could shift the momentum before time runs out.
The House
The House may be in recess, but the players aren’t far from the table. House members are watching the Senate’s every move, trying to influence things, and getting ready to receive the Senate’s revised bill. Even Speaker Johnson is waiting to see how the Senate plays its hand and is constantly reminding the Senate that the House passed its version by a single vote.
Meanwhile, the government funding for FY 26 remains in the air. The House Appropriations Committee has advanced legislation to fund the Department of Defense and the Department of Veterans Affairs. However, a June 11 Appropriations markup of the Ag-FDA funding bill ended after 11 hours when committee Chair Cole (R-OK) realized they wouldn’t be able to finish ahead of the scheduled markup of the defense bill due to numerous amendments that were filed. The House also passed a rescissions package before leaving town with cuts to global HIV/AIDS prevention funding. However, that’s for already approved funding and is considered a dead hand by many in the Senate, including some Republicans.
There you Have It
New NBA and Stanley Cup champions could both be crowned this week—who’s your pick to take it all? Make it a great week!
Many Americans love sports, and members of Congress are no different. A few times a year, lawmakers from both parties gather to play games in a variety of sports with the goal of raising money for charities. Here are some of the games where Representatives and Senators have the chance to take a break from the usual grind of Washington and bring out their inner athlete.
Congressional Baseball Game
Founded in 1909 by a Pennsylvania representative who once played baseball professionally, the Congressional Baseball Game is the oldest of the lawmaker-centric sporting events. In the game, which has been played at Nationals Park since 2008, Democrats and Republicans form different teams and play against one another. Congressional staffers, lawmakers’ families, and even some presidents attend the game, which raises money for four charities: the Boys and Girls Clubs of Greater Washington, the Washington Nationals Dream Foundation, the Washington Literacy Center, and the US Capitol Police Memorial Fund.
Congressional Football Game
Started in 2004, the Congressional Football Game features members of Congress and former National Football League players facing off against the US Capitol Police. An Arizona representative led the effort to start the annual tradition as a way to honor the memory of two Capitol police officers who died in a shooting in 1998. The Congressional Football game raises money for three charities: the US Capitol Police Fund, Our Military Kids, and Advantage 4 Kids.
Congressional Women’s Softball Game
Sen. Susan Collins (R-ME), Sen. Kirsten Gillibrand (D-NY), Rep. Debbie Wasserman Schultz (D-FL) and several other female members of Congress started the Congressional Women’s Softball Game in 2009. Each year, a team consisting of female lawmakers plays against women of the Washington, DC press corps. The game primarily raises money for the Young Survival Coalition, which supports women under 40 who are diagnosed with breast cancer.
Congressional Soccer Match
Founded in 2013, the Congressional Soccer Match consists of separate teams formed by Democratic and Republican lawmakers that play against one another with help from some former professional soccer players. Nearly all lawmakers who participate in the annual event are members of the Congressional Soccer Caucus. The US Soccer Foundation hosts the annual match, which raises funds for several charity programs that help children in underserved communities.
Congressional Hockey Challenge
The Congressional Hockey Challenge began in 2009 from a weekly pickup match consisting of congressional staff and lobbyists. Each year, members of Congress, congressional staff, and administration officials face off against lobbyists, and proceeds from the annual match go towards the Fort Dupont Cannons, USA Warriors Hockey, Capital Beltway Warriors, the Tampa Warriors, and the Professional Women’s Hockey Players Association.
Congressional Basketball Game
First held in 1987, the Congressional Basketball Game ran for 20 consecutive years, featuring Democratic and Republican members competing for charity. In 1999, the format shifted to a matchup between members of Congress and lobbyists. In 2024, the event expanded with the launch of the Women’s Congressional Basketball Game.
